JAMA, BMJ each call for more health app evidence

By Jonah Comstock
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JONAH_COMSTOCK_HEADSHOTTwo of the biggest medical journals in the world have taken up some big picture mobile health questions this week: How are patients to know which medical apps work out of the sea of available options, and should healthy patients be making use of mobile health apps and devices at all?

The first question is the subject of a recent article in the Journal of the American Medical Association, while the second is tackled in a point-counterpoint discussion in the British Medical Journal.

Despite years of talk about app ratings systems and app formularies, the JAMA piece argues, the field is still quite daunting for both doctors and patients, and the apps continue to proliferate. JAMA points to WellDoc's BlueStar as the exception that proves the rule of mobile health apps being generally not well vetted or clinically tested. And though the FDA's recent decisions to explain how they plan to exercise greater regulatory discretion are good for innovation, they add to the supposed problem of patients and doctors not having anywhere to turn for vetted apps.

The JAMA piece isn't concerned with apps like LoseIt! or Fitbit that offer tracking and behavior change for healthy people, or even with general medical advice apps like WebMD. But when it comes to apps aimed at managing a particular disease or condition, there's still a lot of options and not much out there about which actually work.

It's a problem that the market hasn't made as much progress on as might be expected. While HealthTap and IMS are among the companies that have taken it on, if app curation has a home these days, it's in the bespoke app stores that are starting to spring up in hospitals, either online or on-site. Interestingly, this includes the Morristown Medical Center's HealtheConnect store, which is powered by SocialWellth using its Happtique technology. Hospital-based app curation platforms have also cropped up recently at Ochsner Health System and the Cleveland Clinic.

But the JAMA piece suggests an alternate suggestion: that maybe the onus of curation should be on the app makers themselves. WellDoc's journey to clinical validation, FDA clearance, and eventually prescription and reimbursement, was challenging, but now that's been done, it will be easier for the apps that follow in its footsteps. And for developers that really want to make their living providing disease management programs, creating and validating a robust product shouldn't be too much to ask.

If JAMA is raising the question of how consumers know which medical apps to use, though, BMJ is more concerned about wellness apps. And it goes one step further by raising the question of whether consumers should be using health apps at all. In a point-counterpoint, doctors Ilifat Husain and Des Spence argue about whether healthy people should be using apps to monitor their health and promote healthier behavior.

In rather colorful prose ("War, pestilence, and famine are all out to grass; technology, medicine, and overdiagnosis are the new riders of the Apocalypse"), Spence argues that pervasive use of health apps will lead to anxiety and hypochondria and an unhealthy mentality that blames disease on the patient. While some of his arguments seem a bit specious, even Husain, his counterpoint, has to concede the big one: The evidence on whether wellness apps and devices improve clinical outcomes doesn't really exist yet.

That's the common factor that really connects the JAMA and BMJ pieces, other than coincidental timing. They're both calling for evidence in mobile health apps. In JAMA's case it's evidence that particular apps work better than others, and for the BMJ it's evidence that wellness-focused apps in general can make a health difference at all.